Sue Bascombe – with 17 years’ pharmacy experience in management roles and a strong background in Mental Health Services – has been instrumental in successful implementation programs for North Metro Mental Health Services, PBS Reform and the Pharmacy Management Application (PMA). In her current role as Chief Pharmacist for North Metropolitan Health Service Mental Health she has continued to act as an agent for significant change, developing clinical pharmacy services for Mental Health HiTH and in Community Mental Health Clinics. She is passionate about the role pharmacy can play in patient health and wellbeing.
Two recently-completed antipsychotic drug audits have identified that Antipsychotic Polypharmacy (APP) and high-dose antipsychotic prescribing are highly prevalent across inpatient and community mental health settings. There is no convincing evidence that APP is more effective than a single antipsychotic, whereas it has been associated with considerable harm and unnecessary costs. APP results in significantly higher drug costs and increased hospitalization due to non-compliance and drug interactions, and serious side effects such as diabetes, osteoporosis and cardiovascular disease, leading to significant health costs.
North Metropolitan Health Service Mental Health has introduced a program of identification and implementation of best practice strategies to reduce APP and dosing in excess of the TGA-approved manufacturers’ guidelines. The long term goal is to reduce the incidence of these practices to ensure patient safety and therapeutic efficacy.
Using the Antimicrobial Stewardship model, a program of antipsychotic stewardship has been implemented to reduce APP and associated costs. This includes a tool to identify ‘at risk’ patients, a management protocol and education and resources for clinicians to support evidence-based prescribing decisions. The stewardship pharmacist reviews at risk patients, advises prescribers and identifies compliance with the prescribing and monitoring protocols.
A pilot program has been in place at a single community mental health clinic for 12 months. This has identified both the acceptance of the program by prescribers and the effectiveness of clinical pharmacists’ involvement in education, monitoring and de-prescribing.